Association of maternal prenatal copper concentration with gestational duration and preterm birth: a multicountry meta-analysis

BACKGROUND

Copper (Cu), an essential trace mineral regulating multiple actions of inflammation and oxidative stress, has been implicated in risk for preterm birth (PTB).

OBJECTIVES

This study aimed to determine the association of maternal Cu concentration during pregnancy with PTB risk and gestational duration in a large multicohort study including diverse populations.

METHODS

Maternal plasma or serum samples of 10,449 singleton live births were obtained from 18 geographically diverse study cohorts. Maternal Cu concentrations were determined using inductively coupled plasma mass spectrometry. The associations of maternal Cu with PTB and gestational duration were analyzed using logistic and linear regressions for each cohort. The estimates were then combined using meta-analysis. Associations between maternal Cu and acute-phase reactants (APRs) and infection status were analyzed in 1239 samples from the Malawi cohort.

RESULTS

The maternal prenatal Cu concentration in our study samples followed normal distribution with mean of 1.92 μg/mL and standard deviation of 0.43 μg/mL, and Cu concentrations increased with gestational age up to 20 wk. The random-effect meta-analysis across 18 cohorts revealed that 1 μg/mL increase in maternal Cu concentration was associated with higher risk of PTB with odds ratio of 1.30 (95% confidence interval [CI]: 1.08, 1.57) and shorter gestational duration of 1.64 d (95% CI: 0.56, 2.73). In the Malawi cohort, higher maternal Cu concentration, concentrations of multiple APRs, and infections (malaria and HIV) were correlated and associated with greater risk of PTB and shorter gestational duration.

CONCLUSIONS

Our study supports robust negative association between maternal Cu and gestational duration and positive association with risk for PTB. Cu concentration was strongly correlated with APRs and infection status suggesting its potential role in inflammation, a pathway implicated in the mechanisms of PTB. Therefore, maternal Cu could be used as potential marker of integrated inflammatory pathways during pregnancy and risk for PTB.

Selenium Speciation in Paired Whole Blood and Serum Samples From Pregnant Bangladeshi Women

Objectives

We aimed to characterize the relative concentrations of selected major selenium (Se) species in paired whole blood (WB) and serum samples collected from pregnant women at delivery in Dhaka, Bangladesh. Speciation analysis enabled differentiation of organic and inorganic Se, and quantification of the nutritionally bioactive reduced selenometabolite, selenoneine, which has been previously observed in WB from populations with high levels of fish consumption.

Methods

Paired WB and serum specimens (n = 515) were collected at delivery among participants of the Maternal Vitamin D for Infant Growth trial. Quantification of total serum Se and total WBSe was conducted using inductively coupled plasma mass spectrometry (ICP-MS) at the Centers for Disease Control and Prevention (CDC). Speciation analyses were conducted in a subset of pairs (n = 20) to quantify selenometabolites using liquid chromatography coupled to ICP-MS at the University of Cincinnati. Concentrations of inorganic Se (IV), selenoneine, selenocysteine (SeCys), selenomethioneine (SeMet) were expressed as % of total Se. We assessed concordance between results generated across laboratories using paired t-tests.

Results

Overall (n = 515), mean (SD) serum Se and WBSe concentrations (μg/L) were 70 (14) and 135 (18), respectively, such that average Serum Se as a proportion of WBSe was 52%. Findings were similar in the speciation subset (n = 20) [total Serum Se: 82 (19); total WBSe: 138 (18), with a ratio of serum Se to WBSe: 60%]. Sums of quantified species accounted for most of the total serum Se (72 (10); 88% of total) and WBSe (135 (16); 98%). Organic forms were predominant in both serum and WB: SeCys: 15 (2) and 20 (3); and SeMet: 54 (9) and 92 (13), respectively. Selenoneine was detected in WBSe at mean concentrations of 24 (5) μg/L. Together, SeMet and selenoneine accounted for 85% of the additional WBSe not present in serum. Inorganic Se was not detected in WB but comprised 5% of serum.

Conclusions

Approximately half of the Se in whole blood is in the cellular fraction. SeMet was enriched in WB and the most abundant form, relative to selenoneine which was not found in serum. Small amounts of inorganic serum Se may be artifactual due to freeze-thaw related degradation. These findings require confirmation in other settings but suggest that serum Se may not be a suitable biomarker of population status.

Funding Sources

BMGF.

Provision of Small-Quantity Lipid-Based Nutrient Supplements Increases Plasma Selenium Concentration in Pregnant Women in Malawi: A Secondary Outcome of a Randomized Controlled Trial

Background

Pregnant women in Malawi are at risk of selenium deficiency, which can have adverse effects on pregnancy outcomes. Interventions for improving selenium status are needed.

Objectives

To assess the effect of provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to Malawian women during pregnancy on their plasma selenium concentrations at 36 wk of gestation.

Methods

Pregnant women (≤20 wk of gestation) were randomly assigned to receive daily either: 1) iron and folic acid (IFA); 2) multiple micronutrients (MMN; 130 µg selenium per capsule); or 3) SQ-LNS (130 µg selenium/20 g). Plasma selenium concentrations were measured by inductively coupled plasma mass spectrometry at baseline and after ≥16 wk of intervention (at 36 wk of gestation) and compared by intervention group.

Results

At 36 wk of gestation, median (quartile 1, quartile 3) plasma selenium concentrations (micromoles per liter) were 0.96 (0.73, 1.23), 0.94 (0.78, 1.18), and 1.01 (0.85, 1.28) in the IFA, MMN, and SQ-LNS groups, respectively. Geometric mean (GM) plasma selenium concentration was 5.4% (95% CI: 1.8%, 9.0%) higher in the SQ-LNS group than in the MMN group and tended to be higher than in the IFA group (+4.2%; 95% CI: 1.0%, 7.8%). The prevalence of adjusted plasma selenium concentrations <1 µmol/L was 55.1%, 57.8%, and 47.3% in the IFA, MMN, and SQ-LNS groups, respectively; it was lower in the SQ-LNS group than in the MMN group, OR = 0.44 (95% CI: 0.24, 0.83), and tended to be lower than in the IFA group, OR = 0.54 (95% CI: 0.29, 1.03). There was a significant interaction between baseline plasma selenium concentration and intervention group (P = 0.003). In the lowest tertile of baseline selenium concentrations, GM plasma selenium concentration was higher, and the prevalence of low values was lower in the SQ-LNS group compared with the MMN and IFA groups at 36 wk of gestation (P ≤ 0.007).

Conclusions

Provision of SQ-LNS containing selenium to pregnant women can be an effective strategy for improving their selenium status.This trial was registered at clinicaltrials.gov (identifier: NCT01239693).

Maternal selenium levels and whole genome screen in recurrent spontaneous preterm birth population: A nested case control study

OBJECTIVE

To establish if low maternal selenium (Se) was associated with sPTB in women with recurrent sPTB and identify genetic link with maternal Se levels.

DESIGN

Nested case-control study.

SETTING

Tertiary Maternity Hospital.

POPULATION

Plasma and whole blood from pregnant women with history of early sPTB/PPROM < 34⁺⁰ and European ancestry were obtained at 20 weeks (range 15-24 weeks). 'Cases' were recurrent PTB/PPROM < 34⁺⁰ weeks and term (≥37⁺⁰) deliveries were classified as 'high-risk controls.' Women with previous term births and index birth ≥ 39 weeks were 'low-risk controls'.

METHODS

Maternal plasma Se measured by ICP-MS was used as a continuous phenotype in a GWAS analysis. Se was added to a logistic regression model using PTB predictor variables.

MAIN OUTCOME MEASURES

Maternal Se concentration, recurrent early sPTB/PPROM.

RESULTS

53/177 high-risk women had a recurrent sPTB/PPROM < 34⁺⁰weeks and were 2.7 times more likely to have a Se level < 83.3 ppm at 20weeks of pregnancy compared with low-risk term controls (n = 179), (RR 2.7, 95%CI 1.5-4.8; p = .001). One SNP from a non-coding region (FOXN3 intron variant, rs55793422) reached genome-wide significance level (p = 3.73E^-08). Targeted analysis of Se gene variant did not show difference between preterm and term births. (χ² test, OR = 0.95; 95%CI = 0.59-1.56; p = 0.82). When Se levels were added to a clinical prediction model, only an additional 5% of cases (n = 3) and 0.6% (n = 1) of controls were correctly identified.

CONCLUSIONS

Low plasma Se is associated with sPTB risk but is not sufficiently predictive at individual patient level. We did not find a genetic association between maternal Se levels and Se-related genes.

Association of maternal prenatal selenium concentration and preterm birth: a multicountry meta-analysis

BACKGROUND

Selenium (Se), an essential trace mineral, has been implicated in preterm birth (PTB). We aimed to determine the association of maternal Se concentrations during pregnancy with PTB risk and gestational duration in a large number of samples collected from diverse populations.

METHODS

Gestational duration data and maternal plasma or serum samples of 9946 singleton live births were obtained from 17 geographically diverse study cohorts. Maternal Se concentrations were determined by inductively coupled plasma mass spectrometry analysis. The associations between maternal Se with PTB and gestational duration were analysed using logistic and linear regressions. The results were then combined using fixed-effect and random-effect meta-analysis.

FINDINGS

In all study samples, the Se concentrations followed a normal distribution with a mean of 93.8 ng/mL (SD: 28.5 ng/mL) but varied substantially across different sites. The fixed-effect meta-analysis across the 17 cohorts showed that Se was significantly associated with PTB and gestational duration with effect size estimates of an OR=0.95 (95% CI: 0.9 to 1.00) for PTB and 0.66 days (95% CI: 0.38 to 0.94) longer gestation per 15 ng/mL increase in Se concentration. However, there was a substantial heterogeneity among study cohorts and the random-effect meta-analysis did not achieve statistical significance. The largest effect sizes were observed in UK (Liverpool) cohort, and most significant associations were observed in samples from Malawi.

INTERPRETATION

While our study observed statistically significant associations between maternal Se concentration and PTB at some sites, this did not generalise across the entire cohort. Whether population-specific factors explain the heterogeneity of our findings warrants further investigation. Further evidence is needed to understand the biologic pathways, clinical efficacy and safety, before changes to antenatal nutritional recommendations for Se supplementation are considered.